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Health law’s future puts insured in limbo

Nov. 21--Kyla Holtsberry is turning 26 in April, meaning she will have to leave her parents' insurance coverage that she has thanks to the Affordable Care Act.

Knowing she would soon be on her own, she shopped and selected the marketplace plan she would enroll in at that time, one with a premium that is half the cost of her employer's offering.

Now, she fears a repeal of the health-care law commonly known as Obamacare would leave her scrambling to pay for premiums or go without necessary medication to treat her asthma.

In the aftermath of Donald Trump's presidential victory, Toledo-area residents who get their insurance through the Affordable Care Act are left wondering what will happen to health care when he takes office in January. As open enrollment for 2017 continues, insurance and health-care experts are trying to provide as much information as they can to concerned clients, though they admit that they can't predict much past next year's coverage plans.

President-elect Trump long campaigned on a promise to "repeal and replace Obamacare," something that fellow Republicans like Senate Majority Leader Mitch McConnell have called "a high priority."

Since winning the election and meeting with President Obama at the White House, Mr. Trump has indicated he's open to keeping some of the more popular aspects of the law including allowing children to stay on their parents' plans until age 26 and not denying coverage to people with pre-existing conditions.

In an interview with The Wall Street Journal, Mr. Trump said he will consider advice from Mr. Obama about keeping parts of the law.

"I told him I will look at his suggestions, and out of respect, I will do that," Mr. Trump said. "Either Obamacare will be amended, or repealed and replaced."

It is still unclear what will happen to the federal Medicaid and Medicare programs, although Republicans have indicated a desire to overhaul both programs.

Ms. Holtsberry, an Old West End resident, said she is scheduling several doctor appointments in anticipation of an ACA repeal.

"I'm definitely concerned about it," she said. "It's going to be a bigger financial strain. I would have to cut way back to afford health insurance -- that's even if I can get it with a pre-existing condition. I have asthma and that could hike up my rates so high. That's happened in the past."

She recalled her parents paying up to $1,000 a month in premiums or going uninsured and cutting her medication in half to make it stretch further.

"I'm getting prepared to go back to the dark days," she said, adding that she would be scared to go without insurance.

Hearing Mr. Trump's comments about keeping some aspects in place is a little comforting, she said, but she still expects whatever happens to be bad for her.

Enrollment surge

Meanwhile, the Obama Administration is pointing to a post-election enrollment surge as a sign that people like and want to keep the law in place.

U.S. Secretary of Health and Human Services Sylvia Mathews Burwell wrote in a tweet last week that 100,000 people enrolled in insurance plans on the exchange on Nov. 9, the day after the election. In all, she said, more than 1 million people have signed up this year since open enrollment began Nov. 1. Federal officials project 13.8 million people will enroll, up from 12.7 million during last year's enrollment period.

Changes to the country's health-care system are a concern that comes up daily, said Daniel Trombley, a senior coordinator and Medicare broker with Paramount, ProMedica's insurance company.

"This year, more so than other years, I would say from the Medicare and marketplace standpoint, it's almost just like when the Affordable Care Act was going into law," he said. "There is a lot of trepidation ... a lot of anxiety."

Anxiety around the election is added to concerns about changes already announced with the 2017 plans, including increased premiums and fewer choices. Despite mostly flat premiums in Ohio, customers around the state have fewer plans and insurance issuers from which to select.

Mr. Trombley said they try to alleviate the most immediate concerns.

"We try to put people at ease by saying the benefits we have in front of you right now for 2017 are going to be the benefits. They have been filed and approved for the marketplace with the Ohio Department of Insurance and filed with Centers for Medicare and Medicaid. We cannot deviate from what we have filed, nor can they tell us to," he said. "Going forward, at that point we just don't know. We hear what candidates have said during the campaign, but we really don't know what is going to happen relative to the marketplace."

Current law

The Ohio Department of Insurance has said it is operating now as the current law allows.

"Generally, our position is that if a consumer has signed a contract for insurance and pays their premium they should get the service. Of course not knowing what the ACA's future holds, we will continue to regulate insurance companies participating in Ohio's federally administered exchange in accordance to the law," said spokesman Robert Denhard.

Julie Grasson, assistant director of Toledo/Lucas County CareNet, the local agency that oversees the enrollment navigator program, said navigators are still encouraging people to sign up. Questions about the future political implications to health care have been common, but not dominating appointment sessions, she said.

Because of the time required to possibly dismantle the law, Ms. Grasson said she expects the tax penalty for being uninsured to remain in place for some time, so she is advising people to not wait it out.

"My word of advice to consumers is to still sign up. Open enrollment ends Jan. 31, just days past the inauguration," she said. "As of now, it is still the law. We'd hate for people to be locked out because they were waiting for a repeal and it didn't come."

Kevin Schmiel, 62, has three more years before he can transition to Medicare. Until then, he said he's sticking with the Affordable Care Act as long as he can.

Mr. Schmiel, of South Toledo, used to get insurance through his job in the construction field, but the cost made it prohibitive. Last week he found a cheaper plan with the help of a navigator.

He found one that met the criteria to keep his doctors and cover his few prescriptions. His new plan's premium is $300 cheaper with a deductible that is $2,000 lower than his current plan.

Mr. Schmiel enrolled in the marketplace for the first time in 2015, and said he has benefited from the law.

"I'm going to have to wait and see what happens and I'll do whatever they tell me to do," he said. Regardless of what happens, he said he will continue to buy insurance, but he knows plenty of people who would like to see the requirement and tax penalty dropped.

"For me, it's been a good thing," he said, though he dislikes the premium increase proposed under his current plan, which prompted him to shop around again for 2017.

Some in the area are hoping to see changes to the health-care law.

Joni Moreo, 21, of South Toledo, left her navigator appointment without selecting a plan. She needed more information about the insurance offered through her employer. She currently has insurance on the marketplace, but is frustrated that her chiropractic appointments aren't covered.

"I don't really like Obamacare at all," she said. "I don't like that you have to have insurance. ... Everybody thinks you're crazy for thinking that, but it's something I don't think I need right now."

In addition to regular appointments throughout November, CareNet is hosting a final enrollment push on Dec. 15, the last day to get coverage for the new year. The event will be at Mercy Health St. Anne Hospital, 3404 W. Sylvania Ave., from 2 to 9 p.m. in the third floor conference room. Make an appointment by calling 2-1-1.

Enrollees are encouraged to bring photo identification and proof of income to navigator appointments.